II. Exam: Observation

  1. Olecranon Tip and the 2 Epicondyles form:
    1. Elbow extended: transverse line
    2. Elbow flexed: isosceles triangle
  2. Olecranon Tip, Lateral Epicondyle, and Radial head
    1. Forms a posterior-lateral triangle
      1. Occupied by anconeus muscle
    2. Excellent site for joint aspiration
    3. Olecranon bursa often bulges in posterior triangle
      1. Joint effusion bulges into antecubital fossa
  3. Carrying Angle
    1. Neutral elbow position with Forearm supinated
      1. Males: elbow flexed 5-10 degrees
      2. Females: elbow flexed 10-15 degrees
    2. Injury or infection alters angle (young higher risk)
      1. Cubitus varus (gunstock deformity)
        1. Carrying angle reversed
      2. Cubitus valgus

III. Exam: Range of motion

  1. Normal elbow range of motion
    1. Extension: 180 degrees
    2. Flexion: 150 degrees
    3. Pronation: 160-180 degrees
    4. Supination: 90 degrees
  2. Full range of motion nearly excludes elbow Fracture (especially in adults)
    1. Fracture is unlikely (Test Sensitivity 99%) if intact four-way active range of motion
    2. Extension to 180, flexion to 90, supination to 90 and pronation to 180
    3. Vinson (2016) Am J Emerg Med 34(2):235-9 +PMID:26597495 [PubMed]

IV. Exam: Strength (resisted Isometric) Mnemonic

  1. MFP: medial (epicondyle) flexors and pronators
  2. LES: lateral (epicondyle) extensors and supinators

V. Exam: Stability Testing

  1. Varus or Valgus stress
    1. Flex elbow to 30 degrees to unlock olecranon
  2. Ulnar Collateral Ligament Injury most common
    1. Very significant injury for pitchers

VI. Exam: Palpation

  1. Anterior
    1. Biceps tendon
    2. Median Nerve
    3. Anterior capsule
  2. Posterior
    1. Triceps tendon
    2. Olecranon fossa
  3. Medial
    1. Medial epicondyle
    2. Forearm flexor and pronator tendons
    3. Medial collateral ligament
    4. Ulnar Nerve
  4. Lateral
    1. Lateral epicondyle
    2. Radiocapitellar joint
    3. Radial head
    4. Radial Nerve
    5. Ulnar collateral ligament

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